Background The Covid – 19 pandemic overwhelmed health systems, especially, those with poor infrastructure and limited workforces. Healthcare workers face an increased workload, burnout, stress, and increasing incidence of violence as a direct result of the pandemic. If not effectively dealt with, violence against healthcare workers during the pandemic could derail the public health response. In this study, we estimated the prevalence of violence toward healthcare workers during the pandemic in Malawi. We also described the forms and perpetrators, evaluated the predictors, and determined the impact of violence on healthcare workers. Methods We conducted a multicenter, cross-sectional study in six health facilities across three districts in central and southern Malawi. Data collection took place from 22 February – 27 July 2022. We recruited all consenting doctors, clinical officers, nurses, ambulance drivers, health surveillance assistants, and patient attendants who were present on the day of recruitment. Standardized questionnaires were used to collect data on sociodemographic factors and professional characteristics of the healthcare workers. The main outcome measures were personal experiences of physical violence, verbal abuse, and bullying or mobbing during the pandemic. Results We recruited 200 study participants and 70.5% were female. The age range was 20 – 59 with the most common age category being the 25 – 29 age group (24.5%). The overall prevalence of violence was 93% (95% CI: 88.5 – 96.1). The prevalence of physical attacks was 5.5% (95% CI: 2.8 – 9.6%), verbal abuse was 91.5% (95% CI: 86.7 – 95.0), and bullying/mobbing was 79.2% (95% CI: 72.8 – 84.6). Being married (OR: 19, 95% CI: 1.9 – 185.3) and having 6 – 10 staff members working at the same time (OR: 13.8, 95% CI: 1.8 – 107.6) were significantly associated with a physical attack. Being married (OR: 4.7, 95% CI: 1.2 – 18.2), a regular member of staff (OR: 22.6, 95% CI: 1.4 – 410.4), and working with over 15 people at the same time (OR: 25.2, 95% CI: 5.2 – 122.7) were significantly associated with verbal abuse Conclusions The prevalence of violence against healthcare workers was extremely high during the Covid – 19 pandemic. The levels of violence were higher than pre-pandemic levels in the country and higher than levels in other countries during the same period. We recommend immediate actions to address this violence and inclusion of different stakeholders for a multi-sectoral appaorach.

Background The Covid – 19 pandemic overwhelmed health systems, especially, those with poor infrastructure and limited workforces. Healthcare workers face an increased workload, burnout, stress, and increasing incidence of violence as a direct result of the pandemic. If not effectively dealt with, violence against healthcare workers during the pandemic could derail the public health response. In this study, we estimated the prevalence of violence toward healthcare workers during the pandemic in Malawi. We also described the forms and perpetrators, evaluated the predictors, and determined the impact of violence on healthcare workers. Methods We conducted a multicenter, cross-sectional study in six health facilities across three districts in central and southern Malawi. Data collection took place from 22 February – 27 July 2022. We recruited all consenting doctors, clinical officers, nurses, ambulance drivers, health surveillance assistants, and patient attendants who were present on the day of recruitment. Standardized questionnaires were used to collect data on sociodemographic factors and professional characteristics of the healthcare workers. The main outcome measures were personal experiences of physical violence, verbal abuse, and bullying or mobbing during the pandemic. Results We recruited 200 study participants and 70.5% were female. The age range was 20–59 with the most common age category being the 25–29 age group (24.5%). The overall prevalence of violence was 93% (95% CI: 88.5–96.1). The prevalence of physical attacks was 5.5% (95% CI: 2.8–9.6%), verbal abuse was 91.5% (95% CI: 86.7–95.0), and bullying/mobbing was 79.2% (95% CI: 72.8–84.6). Being married (OR: 19, 95% CI: 1.9–185.3) and having 6–10 staff members working at the same time (OR: 13.8, 95% CI: 1.8–107.6) were significantly associated with a physical attack. Being married (OR: 4.7, 95% CI: 1.2–18.2), a regular member of staff (OR: 22.6, 95% CI: 1.4–410.4), and working with over 15 people at the same time (OR: 25.2, 95% CI: 5.2–122.7) were significantly associated with verbal abuse Conclusions The prevalence of violence against healthcare workers was extremely high during the Covid – 19 pandemic. The levels of violence were higher than pre-pandemic levels in the country and higher than levels in other countries during the same period. We recommend immediate actions to address this violence and inclusion of different stakeholders for a multi-sectoral appaorach.